Young Adults Research Articles

Reliability of Obstacle-Crossing Parameters during Overground Walking in Young Adults

We aimed to evaluate the intra-session relative and absolute reliability of obstacle-crossing parameters during overground walking in young adults, and to determine the number of trials required to ensure reliable assessment. We analysed data from 43 young male adults who were instructed to walk at a self-selected velocity on a pathway and to step over an obstacle (height = 15 cm; width = 80 cm, thickness = 2 cm) three times. Spatial–temporal gait parameters of the approaching and crossing phases (i.e., before and after the obstacle) and obstacle clearance parameters (i.e., vertical and horizontal distance between the foot and the obstacle during crossing) were computed using a three-dimensional motion analysis system. Intraclass correlation coefficients were used to compute the relative reliability, while standard error of measurement and minimal detectable change were used to assess the absolute reliability for all possible combinations between trials. Results showed that most spatial–temporal gait parameters and obstacle clearance parameters are reliable using the average of three trials. However, the mean of the second and third trials ensures the best relative and absolute reliabilities of most obstacle-crossing parameters. Further works are needed to generalize these results in more realistic conditions and in other populations.

Cryoballoon ablation for atrial fibrillation in young adults: a propensity-score matching comparison with an older cohort

Abstract Background Cryoballoon ablation (CB-A) has proven to be a valid technology for achieving pulmonary vein isolation (PVI) in patients affected by symptomatic atrial fibrillation (AF). Data regarding CB-A in young adults are still scarce and mainly derived from studies performed without balancing comorbidities and echocardiographic parameters between the groups. The present study aimed to focus on the outcomes and complications of CB-A PVI in young adults (< 50 years) compared to a propensity score-matched population of older individuals, seeking also to understand the true role of "age" as potential risk factor for arrhythmia recurrences. Methods and results We retrospectively enrolled 172 consecutive patients aged < 50 years who underwent PVI employing the second-generation cryoballoon (CB-2). A 1:1 propensity score matching comparison with an older cohort of patients was performed and 290 patients (145 subjects aged < 50 years vs. 145 patients aged ≥ 50 years) were then selected. The mean age was 43.3 ± 4.9 years in the younger group and 64.7 ± 8.7 years in the control group (p < 0.001). After an overall median follow-up of 18 [12 - 29] months, the Kaplan-Meier curves showed a similar rate of freedom from arrhythmia relapses between the younger and the older cohorts (85.5% vs. 77.2% respectively, log-rank p = 0.31). The rate of major complications was low (2.8 %) and did not significantly differ between the groups, being 2.1% for the younger cohort and 3.5% for the older group (p = 0.50). Vascular complications and phrenic nerve palsy appeared to be the most common procedure-related adverse events, occurring in 8 (2.8%) patients. Arrhythmia recurrences during blanking period (ERAF) was found to be the only independent predictor of late AT/AF relapses. Conclusions Our propensity-score model demonstrates that CB-A PVI is equally safe and effective in young adults as it is in older individuals. Furthermore, our findings suggest that "age" itself does not appear to play a significant role in predicting recurrences after CB-A PVI. This result underscores the importance of controlling the modifiable risk factors (comorbidities) and emphasizes the value of early AF diagnosis and intervention.Survival Curve

'It's the wild west out there': A qualitative study of the views and preparedness of health professionals in helping young adult e-cigarette users to quit.

Young adults are attempting to quit vaping, with many accessing smoking cessation programs with a lack of reported efficacy, highlighting the need for targeted vaping cessation support. Young people report seeing health professionals as potential sources of support in the quitting process. Additionally, the current changing regulatory landscape around vaping in Australia potentially increases numbers of those seeking health professional help for cessation. However, limited research exists on health professionals' views and preparedness to assist young adults with their vaping cessation; thus, this exploratory study aimed to gain insights into their readiness to support young adults in quitting vaping. Data were gathered via eight co-design workshops (two groups each of two hours duration and six semi-structured interviews of 1 hour duration), facilitated online with 12 health professionals. Data underwent thematic analysis. Health professionals expressed a need for more information in supporting young adults to quit vaping, with them presently relying on informal pathways of support and information for their practice. Participants reported a lack of evidence-based guidelines and a reluctance to prescribe nicotine vapes, expressing conflict with the changing regulatory landscape in Australia. Our findings identify a significant gap in health professional preparedness in supporting vaping cessation. Health professionals are working within a rapidly evolving regulatory environment and are feeling unprepared to address the widely spread issue of vaping, especially among young people. We demonstrate the critical need for guidelines and training of health professionals to enable them to better support young people in quitting vaping. This qualitative study offers unique insights into the views and readiness of Australian health professionals to support young people to quit vaping, specifically in the context of recent regulatory reforms. The results highlight the need for evidence-based guidance and training for health professionals to inform their vaping cessation support practice.

Metabolic and Low-Grade Inflammation Risk in Young Adults with a History of Extrauterine Growth Restriction

Children with a history of extrauterine growth restriction (EUGR), later at prepubertal age, exhibit an increased metabolic risk including risen insulin resistance and low-grade inflammation. However, the progression of such metabolic changes after puberty and the lasting health implications have not yet been investigated. The objective of this study was to ascertain whether young adults with a history of EUGR faced increased vulnerability to metabolic disorders. A study was conducted comparing a group of adults with a history of EUGR with a healthy reference group. A total of 110 young adults (36 from the EUGR group and 74 from the control group) were included. Anthropometric variables, blood pressure (BP), general biochemical parameters, plasma inflammatory biomarkers, and adipokines were assessed. Compared to the reference group, the EUGR group had a shorter height and body weight with higher lean mass and waist circumference, as well as a greater percentage of individuals with high BP. In addition, EUGR patients had higher values of insulin, HOMA-IR, nerve growth factor, and leptin, and lower levels of adiponectin and resistin. The present study suggests that young adults with a history of EUGR present increased metabolic risk factors therefore, clinical follow-up should be considered.

Abnormal vascular thickness and stiffness in young adults with type 1 diabetes: new insights from cutting-edge ultrasound modalities

BackgroundCardiovascular disease (CVD) remains the leading cause of morbidity and mortality in patients with Type 1 Diabetes (T1D). Early markers of CVD include increased carotid intima-media thickness (CIMT) and pulse wave velocity (PWV), but these existing ultrasound technologies show limited spatial and temporal resolution in young adults. The purpose of this study is to evaluate the utility of high-resolution ultrasound modalities, including high frequency ultrasound CIMT (hfCIMT) and ultrafast ultrasound PWV (ufPWV), in young adults with Type 1 Diabetes.MethodsThis is a prospective single-center observational cohort study including 39 participants with T1D and 25 age and sex matched controls. All participants underwent hfCIMT and ufPWV measurements. hfCIMT and ufPWV measures of T1D were compared with controls and associations with age, sex, BMI, A1c, blood pressure, and lipids were studied.ResultsMean age was 24.1 years old in both groups. T1D had a greater body mass index (27.7 [5.7] vs 23.1 [3.2] kg/m2), LDL Cholesterol, and estimated GFR, and had a mean A1c of 7.4 [1.0] % (57 mmol/mol) and diabetes duration of 16.1 [3.7] years with 56% using insulin pumps. In T1D, hfCIMT was significantly increased as compared to controls (0.435 ± 0.06 mm vs 0.379 ± 0.06 mm respectively, p < 0.01). ufPWV measures were significantly increased in T1D (systolic foot PWV: 5.29 ± 0.23 m/s vs 5.50 ± 0.37 m/s, p < 0.01; dicrotic notch PWV = 7.54 ± 0.46 m/s vs 7.92 ± 0.41 m/s, p < 0.01). Further, there was an impact of A1c-measured glycemia on hfCIMT, but this relationship was not seen with ufPWV. No significant statistical correlations between hfCIMT and ufPWV measures in either T1D or healthy controls were observed.ConclusionYoung adults with T1D present with differences in arterial thickness and stiffness when compared with controls. Use of novel high-resolution ultrasound measures describe important relationships between early structural and vascular pathophysiologic changes and are promising tools to evaluate pre-clinical CVD risk in youth with T1D.Trial Registration: ISRCTN91419926.

Amyloid-β Deposition Predicts Grocery Shopping Performance in Older Adults Without Cognitive Impairment

Background: A screening tool sensitive to Alzheimer’s disease (AD) risk factors, such as amyloid-β (Aβ) deposition, and subtle cognitive changes, best elicited by complex everyday tasks, is needed. Objective: To determine if grocery shopping performance could differentiate older adults at elevated risk of developing AD (OAer), older adults at low risk of developing AD (OAlr), and young adults (YA), and if amount of Aβ deposition could predict grocery shopping performance in older adults (OA). Methods: Twenty-one OAer (78±5 years), 33 OAlr (78±5 years), and 28 YA (31±3 years) performed four grocery shopping trials, with the best and worst performances analyzed. Measures included trial time, number of correct items, number of grocery note fixations, and number of fixations and percentage of time fixating on the correct shelving unit, correct brand, and correct shelf. Linear mixed effects models compared measures by performance rank (best, worst) and group (OAer, OAlr, YA), and estimated the effect of Aβ deposition on measures in OA. Results: Relative to their best performance, OAer and OAlr exhibited more correct shelving unit fixations and correct brand fixations during their worst performance, while YA did not. Within OA’s worst performance, greater Aβ deposition was associated with a smaller percentage of time fixating on the correct shelving unit, correct shelf, and correct brand. Within OA, greater Aβ deposition was associated with more grocery note fixations. Conclusions: OA with elevated Aβ deposition may exhibit subtle working memory impairments and less efficient visual search strategies while performing a cognitively demanding everyday task.

Innovating in the Detection of Depression in Young Adults: Development of a Mobile Application Based on the Enhanced Cascade Model

Depression is a disorder that usually begins in early adulthood, having a duration according to the World Health Organization (WHO) from a couple of months to a couple of years, however, in approximately 20% of cases there is a chronic evolution that results in a high mortality rate by suicide due to lack of adequate treatment. Therefore, the objective of this project is to facilitate the tools for an adequate care of depression, mainly in young adults through the development of a mobile application that monitors patients. To carry out the project, the enhanced cascade model was implemented, because the feedback between the different phases of the system development life cycle is important to make the appropriate modifications. The application of interviews and the use of brainstorming were the selected way in which all the system requirements were designed and the goals to be met by the system were adequately defined.

P.032 The importance of transition clinics: A chart-review examining demographic, health, and social variables in young adults with epilepsy who were recently transitioned

Background: Research consistently shows that adolescents transitioning from pediatric to adult care struggle. Although data looking at young adults with epilepsy is limited, research suggests that these adults tend to have higher rates of depression and anxiety, lower rates of medication compliance, and lower education. Methods: To better understand this population and their struggles, a retrospective chart review of 58 patients transferred from pediatric to adult care was done. Results: 39.7% of participants were lost to follow-up; 12 were temporarily lost (average 1.3 years) and 11 were permanently lost. Twenty-three participants admitted to medication non-compliance, with fifteen having break-through seizures. Of the 45 patients that filled out mental health assessments at initial visit, 28.9% met the threshold for major depressive disorder, and 56.6% of patients had symptoms of anxiety. Data found that at one-year follow-up, 60% of these patients had similar or worsened depression scores, and 64% had similar or worsened anxiety scores. Conclusions: The findings of this study are concerning and highlight the need for greater education and support for these adolescents. Specifically, patients need more education on the importance of consistent follow-ups and consistently taking medication. Findings also suggest the importance of assessing and addressing mental health concerns.

Looking beyond Body Structure and Function: ICF Foci and Who Is Being Assessed in Research about Adolescents and Young Adults with Cerebral Palsy—A Scoping Review

Purpose: The purpose of this study is to summarize the ICF foci, looking beyond body structures and function, and to analyze who has been assessed in research about adolescents and young adults (AYAs) with CP in the phase of transition to adulthood. Method: Medline, EMBASE, PsycINFO, and CINAHL databases were searched using terms related to cerebral palsy, adolescents/young adults, health development, participation, and independence. Studies including youth with CP (13–30 years old) published in English from 2014 to 2021 were considered. The methods of assessment reported in the included studies were used to identify the ICF foci and who was assessed. Results: In this study, 86 studies were reviewed. The main ICF foci are activity and participation (51% of the studies), personal factors (23%), ICF not covered (14%), ICF not defined (9%), with environmental factors being the least focused ICF component (3%). Most studies assessed AYAs directly (49% of studies). Conclusions: Activity- and participation-related constructs are the leading research focus of studies, and more attention is needed concerning environmental factors. AYAs are the main source of information, and the perspectives of other key figures are also being valued. To bridge the gap between child and adult health care, a broader view of health development and approaches to explore AYA developmental issues must be taken.

P.017 Ischemic stroke in young adults: a comparison of outcomes, stroke risk factors and etiologies between males and females

Background: The primary aim was to determine if functional outcomes among young adults with stroke differed based on sex. The secondary aim was to identify differences in stroke risk factors and etiologies between females and males. Methods: Retrospective analysis of acute ischemic stroke patients aged 18 to 55 years from a stroke registry between 2018 to 2022. Multivariable logistic regression to analyse if modified Rankin Scale at 3-6 months (mRS, 0-2 versus 3-6) was associated with sex. Results: 315 patients (127 female), median age 48 years (IQR 42-52), median NIHSS 10 (IQR 4-19, median mRS (3-6 months) 2 (IQR 1-3). Following adjustment for vascular risk factors, clinical stroke characteristics, baseline mRS and stroke time metrics no significant difference in mRS (3-6 months) based on sex (p=0.40). Females more frequently had an unknown time of stroke onset (p=0.03). Large-artery atherosclerosis as a stroke etiology (p=0.01), known atrial fibrillation (p=0.03) and drug use (p=0.003) were more frequent in males. Conclusions: Patient-oriented outcomes maybe of interest in future studies as functional mRS outcomes do not differ between young male and female stroke patients. Males had a higher prevalence of large-artery atherosclerosis and risk factors including drug use and atrial fibrillation. These findings could help develop targeted stroke prevention strategies.

Preconception Care Interventions for Adolescents and Young Adults to Prevent Adverse Maternal and Child Health Outcomes: Protocol for an Evidence Gap Map.

Preconception is the period before a young woman or woman conceives, which draws attention to understanding how her health condition and certain risk factors affect her and her baby's health once she becomes pregnant. Adolescence and youth represent a life-course continuum between childhood and adulthood, in which the prepregnancy phase lacks sufficient research. The aim of the study is to identify, map, and describe existing empirical evidence on preconception interventions that enhance health outcomes for adolescents, young adults, and their offspring. We will conduct an evidence gap map (EGM) activity following the Campbell guidelines by populating searches identified from electronic databases such as MEDLINE, Embase, CINAHL, and Cochrane Library. We will include interventional studies and reviews of interventional studies that report the impact of preconception interventions for adolescents and young adults (aged 10 to 25 years) on adverse maternal, perinatal, and child health outcomes. All studies will undergo title or abstract and full-text screening on Covidence software (Veritas Health Innovation). All included studies will be coded using the Evidence for Policy and Practice Information (EPPI) Reviewer software (EPPI Centre, UCL Social Research Institute, University College London). Cochrane Risk of Bias tool 2.0 and Assessing the Methodological Quality of Systematic Reviews-2 (AMSTAR-2) tool will be used to assess the quality of the included trials and reviews. A 2D graphical EGM will be developed using the EPPI Mapper software (version 2.2.4; EPPI Centre, UCL Social Research Institute, University College London). This EGM exercise began in July 2023. Through electronic search, 131,031 publications were identified after deduplication, and after the full-text screening, 18 studies (124 papers) were included in the review. We plan to submit the paper to a peer-reviewed journal once it is finalized, with an expected completion date in May 2024. This study will facilitate the prioritization of future research and allocation of funding while also suggesting interventions that may improve maternal, perinatal, and child health outcomes. DERR1-10.2196/56052.

Sex differences in electrolyte abnormalities indicating refeeding syndrome risk among hospitalized adolescents and young adults with eating disorders

BackgroundRefeeding syndrome is the gravest possible medical complication in malnourished patients undergoing refeeding in the hospital. We previously reported that males with malnutrition secondary to eating disorders required more calories and had longer hospital stays than females; however, sex differences in electrolyte abnormalities indicating refeeding syndrome risk remain unknown. The objective of this study was to assess differences in electrolyte abnormalities indicating refeeding syndrome risk among male and female adolescents and young adults with eating disorders hospitalized for medical instability.MethodsWe retrospectively reviewed the electronic medical records of 558 patients aged 9–25 years admitted to the University of California, San Francisco Eating Disorders Program for medical instability between May 2012 and August 2020. Serum was drawn per standard of care between 5 and 7 am each morning and electrolyte abnormalities indicating refeeding syndrome risk were defined as: hypophosphatemia (< 3.0 mg/dL), hypokalemia (< 3.5 mEq/L), and hypomagnesemia (< 1.8 mg/dL). Logistic regression was used to assess factors associated with electrolyte abnormalities indicating refeeding syndrome risk.ResultsParticipants included 86 (15.4%) males and 472 (84.6%) females, mean (SD) age 15.5 (2.8) years. Rates of refeeding hypophosphatemia (3.5%), hypokalemia (8.1%), and hypomagnesemia (11.6%) in males hospitalized with eating disorders were low, with no statistically significant differences from females. Older age was associated with higher odds of refeeding hypophosphatemia and hypomagnesemia. Lower percent median body mass index and greater weight suppression at admission were associated with higher odds of refeeding hypophosphatemia.ConclusionsRates of electrolyte abnormalities indicating refeeding syndrome risk were low in males hospitalized for eating disorders and rates did not significantly differ from females. Together with our finding that males have higher caloric requirements and longer hospital length of stay, the finding that electrolyte abnormalities indicating refeeding syndrome risk were not greater in males than females supports future research to evaluate the safety and efficacy of higher calorie and/or faster advancing refeeding protocols for males.

Romiplostim for Treatment of Children and Young Adults With Severe Aplastic Anemia and Myelodysplastic Syndrome.

Thrombopoietin receptor agonists (TPO-RAs) induce trilineage hematopoiesis under conditions with acquired hematopoietic failure. We evaluated safety, tolerability, and preliminary efficacy of a TPO-RA, romiplostim (Nplate), with or without standard-of-care immunosuppressive therapy (±IST) for children (ages <21y) with newly diagnosed and relapsed/refractory severe aplastic anemia (SAA) and myelodysplastic syndrome (MDS). Data were collected from an observational study and a single arm interventional pilot study. The safety outcome was treatment-related adverse events (AEs). Efficacy was evaluated by complete hematopoietic response (CHR) at week 24. Romiplostim was commenced at 5µg/kg/week, with dose escalation of 2.5µg/kg/week (maximum, 20µg/kg/dose) based on platelet response. Romiplostim was continued until CHR was observed. Ten subjects (SAA, 9 [IST, 4; without IST, 5]; MDS, 1) completed the study (median age: 9.2y). Median romiplostim dose was 10µg/kg/week (range: 5 to 17.5µg/kg/week). The cumulative incidence of CHR was 70.4% (95% CI, 20.2%-92.6%). Among 21 AEs (Grade 1 to 3), 3 were attributed to romiplostim. At a median posttherapy follow-up of 10.9 months (range: 0.7 to 77.5), no clonal evolution, bone marrow fibrosis or mortality was reported. This proof-of-concept study provides data about short-term safety, tolerability, and preliminary efficacy of romiplostim (±IST) for treatment of pediatric SAA/MDS.

Knowledge, Attitude and Practices (KAP) of Sterilization and Disinfection of Health Care Professionals in Bangladesh

&amp;lt;i&amp;gt;Background:&amp;lt;/i&amp;gt; Healthcare professionals face a constant risk of acquiring infections from patients. Exposure to blood, saliva, and sharp instruments increases their susceptibility to various infectious diseases. Proper sterilization and disinfection procedures are crucial for protecting both healthcare workers and patients. &amp;lt;i&amp;gt;Objective:&amp;lt;/i&amp;gt; This study aimed to assess the knowledge, attitude, and practices regarding sterilization and disinfection among healthcare professionals in Bangladesh.&amp;lt;i&amp;gt; Methods&amp;lt;/i&amp;gt;: A cross-sectional study was conducted at the National Institute of Cardiovascular Diseases &amp; Hospital in Dhaka, Bangladesh, from January to June 2023. A total of 81 healthcare professionals were randomly selected and participated in the study after providing verbal consent. Data collection involved a pre-structured questionnaire focusing on knowledge, attitude, and practices related to sterilization and disinfection. Statistical analysis was performed using SPSS software, and results were presented as frequencies and percentages. Ethical clearance was obtained before the study commenced. &amp;lt;i&amp;gt;Results: &amp;lt;/i&amp;gt;The study included healthcare professionals from various backgrounds, with the majority being young adults (21-25 years old). Knowledge assessment revealed a good understanding of sterilization methods, disinfection procedures, post-sterilization instrument management, and waste disposal practices. Additionally, most participants were aware of the hospital&amp;apos;s sterilization protocols and infection prevention policies. Regarding attitudes, a positive response was observed towards regular training for staff, proper use of personal protective equipment (PPE), and adherence to sterilization and disinfection guidelines. However, a minority expressed concerns about reusing disposable items. Practices reflected the positive knowledge and attitudes, with a high percentage of participants following hand hygiene protocols, using PPE, and opting for disposable equipment. However, a small number reported experiencing needle-stick injuries, highlighting a potential gap between knowledge and practice. &amp;lt;i&amp;gt;Conclusions:&amp;lt;/i&amp;gt; the study found that a majority of healthcare professionals in this setting demonstrated good knowledge, positive attitudes, and appropriate practices regarding sterilization and disinfection. However, a small knowledge, attitude, and practice gap was identified, particularly concerning needle-stick injuries. These findings suggest a need for ongoing education and reinforcement of safe practices to ensure optimal infection prevention and control in healthcare facilities.

Enabling health literate behavior at vocational education and training settings for adolescents and young adults with chronic conditions: a type-building approach

Zusammenfassung Hintergrund Junge Erwachsene mit chronischen Erkrankungen sind in der Ausgestaltung von institutionellen Rahmenbedingungen in berufsbildenden Kontexten bisher kaum berücksichtigt. Gleichzeitig benötigen sie abseits von beruflichen Handlungskompetenzen jedoch auch entsprechende Gesundheitskompetenzen, um mit der eigenen Erkrankung in berufsbezogenen Kontexten adäquat umzugehen. Ziel Auf der Basis von typenbildend herausgearbeiteten Performanzformen werden Implikationen aufgezeigt, anhand derer es auf organisationaler Ebene ermöglicht werden kann, Voraussetzungen für gesundheitskompetentes Verhalten zu schaffen sowie individuelle Gesundheitskompetenzen in berufsbildenden Kontexten zu fördern. Methodik Es wurden 12 biographische Interviews mit chronisch erkrankten jungen Erwachsenen (Epilepsie und Diabetes mellitus Typ 1) geführt und anhand der dokumentarischen Methode typenbildend analysiert. Der rekonstruktive Forschungsansatz ermöglicht sowohl die Einbindung lebensweltspezifischer Perspektiven als auch die interdisziplinäre Verzahnung gesundheitswissenschaftlicher und berufspädagogischer Forschungsansätze. Ergebnisse und Schlussfolgerung Für ausbildungs- und berufsbezogene Kontexte lassen sich vier Performanzformen als Ausdruck von Gesundheitskompetenz differenzieren. Darüber hinaus wurden Faktoren abgeleitet, die als Gelingensbedingungen auf individueller und struktureller Ebene fungieren. Diese können wiederum zum Anlass genommen werden, um berufsbildende Settings entsprechend gesundheitskompetenzförderlich zu gestalten.

Exploring the Health-Related Quality of Life and the Lived Experience of Adolescents Following Invasive Meningococcal Disease

Background: Data on the health-related quality of life (HRQoL) for invasive meningococcal disease (IMD) survivors, particularly among adolescents and young adults (AYAs), are limited. This study aimed to investigate the in-depth experiences and impacts of IMD on AYAs. Methods: Participants were recruited from two Australian states, Victoria and South Australia. We conducted qualitative, semi-structured interviews with 30 patients diagnosed with IMD between 2016 and 2021. The interview transcripts were analyzed thematically. Results: Of the participants, 53% were aged 15–19 years old, and 47% were aged 20–24. The majority (70%) were female. Seven themes relating to the participants’ experience of IMD were identified: (1) underestimation of the initial symptoms and then rapid escalation of symptoms; (2) reliance on social support for emergency care access; (3) the symptoms prompting seeking medical care varied, with some key symptoms missed; (4) challenges in early medical diagnosis; (5) traumatic and life-changing experience; (6) a lingering impact on HRQoL; and (7) gaps in the continuity of care post-discharge. Conclusion: The themes raised by AYA IMD survivors identify multiple areas that can be addressed during their acute illness and recovery. Increasing awareness of meningococcal symptoms for AYAs may help reduce the time between the first symptoms and the first antibiotic dose, although this remains a challenging area for improvement. After the acute illness, conducting HRQoL assessments and providing multidisciplinary support will assist those who require more intensive and ongoing assistance during their recovery.

Illicit over the counter availability and recreational use of Zolpidem by young adults: A letter to the editor

Dear Editor, Zolpidem is a sedative-hypnotic drug that acts as a Central Nervous System (CNS) depressant by acting on GABA receptors. This drug, brand name Ambien, is prescribed mainly for short-term treatment of sleeping problems. However, recent trials and research also show its efficacy in treating various neurological disorders. It is one of the safest drug choices for insomnia, but like any other drug, it has various side effects that include nausea, vomiting, allergies, dizziness, metallic taste, etc. However, some of the concerning side effects include amnesia, parasomnia, and behaviour changes, including hallucinations, delusions, and depression (1). ‘Ambien Zombie’ was a term coined to describe people under the effect of the medication as they got involved in embarrassing activities including sleepwalking. It is a Schedule 4 drug, which means ‘prescription only medicine’ as it has viable medical use but also a low probability of misuse or abuse. Despite the potentially alarming side effects in addition to dependence, which has been reported several times (1), it is becoming increasingly popular among young adults, including students, to use it for various purposes, including and especially recreational. These purposes are sleep, relief from anxiety or depression, feeling good, getting high, relaxing or zoning out, and out of curiosity, while some also use it to perform better at school (2,3). The calming effect of zolpidem on the brain gives a drugged effect, allowing the person to carry out compulsive activities and behaviour, hence called an ‘Ambien Zombie’ while most of the time, forgetting about it the next day (anterograde amnesia) (4). Even after realising this side of drug use, young adults use it for fun to feel disinhibited, or to achieve a euphoric state without any embarrassment. The issue of concern is the widespread availability of this drug in pharmacies. As it is a class 4 drug, it should be given on a doctor’s prescription only. However, it is unfortunate that this is not being followed, especially in Pakistan. While some pharmacies ask for a prescription, the majority give it away freely to anyone asking for it, be it a student or a young doctor prescribing himself. This was mainly due to nonqualified salesmen in the pharmacies becoming a source of illicit sale practice for nonmedical prescription drug use (5). This easy accessibility of Zolpidem has rendered it to be a recreational drug for the youth. ---Continue

Effect of Third Molar Surgery on Sleep Health Parameters of Young Adults: An Observational Study

Background and Objectives: The role of surgical extraction of the third molar in patients’ sleep quality remains unclear, although it is one of the most common oral surgical procedures. The aim of this study is to assess the changes in patient-reported sleep health outcomes after third molar surgery and to investigate any associations between sleep parameters and post-extraction pain. Materials and Methods: Young adults without known comorbidities who were in need of mandibular third molar surgical extraction were included. All participants completed a sleep diary, the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and Athens Insomnia Scale (AIS) questionnaires, which were used to assess sleep habits, daytime sleepiness, sleep quality and insomnia severity one week before and after extraction. In addition, a visual analog scale was completed postoperatively to assess the perception of pain. Results: Out of 75 patients who completed the study protocol, 32 (42.7%) were males and 43 (57.3%) were females, with a mean age of 24.01 (±3.43) years. Postoperatively, statistically significant higher scores were observed for PSQI [4.85 (±2.32) before vs. 5.39 (±2.75) after, p = 0.041], AIS [5.56 (±3.23) before vs. 6.91 (±4.06) after, p &lt; 0.001] and average weekly number of nocturnal awakenings [2.01 (±3.72) before vs. 4.19 (±5.20) after, p &lt; 0.001] but not for ESS, average weekly sleep duration and average weekly sleep onset latency. Pain perception was increased in patients who slept worse on almost all seven postoperative days, although this did not reach statistical significance. Conclusions: Third molar surgery impacts sleep quality and insomnia severity in the first week after extraction, while there is no effect on daytime sleepiness. The worsening of subjective sleep symptoms after extraction may be associated with an increased perception of pain.

Tuberculosis Immunoreactivity Surveillance in Malawi (Timasamala)-A protocol for a cross-sectional Mycobacterium tuberculosis immunoreactivity survey in Blantyre, Malawi.

Tuberculosis (TB) transmission and prevalence are dynamic over time, and heterogeneous within populations. Public health programmes therefore require up-to-date, accurate epidemiological data to appropriately allocate resources, target interventions, and track progress towards End TB goals. Current methods of TB surveillance often rely on case notifications, which are biased by access to healthcare, and TB disease prevalence surveys, which are highly resource-intensive, requiring many tens of thousands of people to be tested to identify high-risk groups or capture trends. Surveys of "latent TB infection", or immunoreactivity to Mycobacterium tuberculosis (Mtb), using tests such as interferon-gamma release assays (IGRAs) could provide a way to identify TB transmission hotspots, supplementing information from disease notifications, and with greater spatial and temporal resolution than is possible to achieve in disease prevalence surveys. This cross-sectional survey will investigate the prevalence of Mtb immunoreactivity amongst young children, adolescents and adults in Blantyre, Malawi, a high HIV-prevalence city in southern Africa. Through this study we will estimate the annual risk of TB infection (ARTI) in Blantyre and explore individual- and area-level risk factors for infection, as well as investigating geospatial heterogeneity of Mtb infection (and its determinants), and comparing these to the distribution of TB disease case-notifications. We will also evaluate novel diagnostics for Mtb infection (QIAreach QFT) and sampling methodologies (convenience sampling in healthcare settings and community sampling based on satellite imagery), which may increase the feasibility of measuring Mtb infection at large scale. The overall aim is to provide high-resolution epidemiological data and provide new insights into methodologies which may be used by TB programmes globally.

WALKING IN THEIR SHOES: A PHENOMENOLOGICAL STUDY OF THE LIVED EXPERIENCES OF TEACHERS MANAGING STUDENTS WITH DISRUPTIVE BEHAVIOR

This study focuses primarily on the lived experiences of secondary education teachers who work with students exhibiting disruptive behavior. The research employs a qualitative phenomenological approach, utilizing semi-structured in-depth interviews with a sample of five teachers from a secondary school in Barangay Sigaboy who are responsible for managing students with disruptive conduct. The selection of participants was done through purposive sampling. Thematic analysis was employed to evaluate the data, which facilitated the identification of key statements pertaining to the challenges, coping methods, and insights of secondary teachers in managing disruptive conduct exhibited by their students. Upon deliberation, 2 general themes surfaced breaking into 2 subthemes of each result. The results have shown that the first theme: learner’s background have described the types of learners and the reason for disruptions. It is evident that secondary teachers experience varied learners that disrupts the learning process and carries different reason of disruptions. The second theme: academic background exposed the teachers’ emotional attachments and strategies in the disruptive behavior. This study describes the lived experiences of 5 secondary teachers in the journey of educating young adults. KEYWORDS: Secondary Teachers, Disruptive Behavior, Lived Experience